Gynecologic oncology最新文献

{"title":"Trends in sentinel lymph node evaluation for vulvar melanoma in the United States from 2012 to 2018","authors":"Stephanie Alimena ,&nbsp;Hadley Reid ,&nbsp;Alexandra Bercow ,&nbsp;Colleen Feltmate ,&nbsp;Jessica St Laurent ,&nbsp;Taymaa May ,&nbsp;Ross Berkowitz ,&nbsp;Neil Horowitz ,&nbsp;Michelle Davis","doi":"10.1016/j.ygyno.2025.04.007","DOIUrl":"10.1016/j.ygyno.2025.04.007","url":null,"abstract":"<div><h3>Objective</h3><div>To describe trends in type of lymph node assessment for vulvar melanoma over time and factors associated with sentinel lymph node biopsy (SLNB).</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of patients in the National Cancer Database (NCDB) with vulvar melanoma from 2012 to 2018. Type of lymph node evaluation, demographic and clinical characteristics, and characteristics of the treating institution were abstracted. Chi square and multivariate logistic regression were used to evaluate predictors of SLNB compared to inguinofemoral lymph node dissection (IFLD) and no lymph node evaluation.</div></div><div><h3>Results</h3><div>A total of 1828 patients with vulvar melanoma were identified. Of those, 925 (50.6 %) underwent lymph node evaluation, 357 (38.6 %) with SLNB alone, 97 (10.5 %) with SLNB and IFLD, and 471 (50.9 %) with IFLD alone. Year of diagnosis, age, T stage, insurance status, facility type, and facility volume were significant predictors of use of SLNB in univariate analyses. Age, year of diagnosis, T stage and facility type remained significant in multivariate analysis. SLNB was most often performed for T1 and T2 lesions (31.3 % and 36.2 %, respectively), while only 19.6 % of T3, 1.3 % of T4, and 25.8 % of those with unknown T stage underwent SLNB. Survival outcomes were similar regardless of mode of lymph node assessment, but worse in those who received no assessment.</div></div><div><h3>Conclusions</h3><div>Current practice in the United States for lymph node evaluation in vulvar melanoma differs from the recommended guidelines for cutaneous melanomas by T stage. Updated guidelines for vulvar melanoma aligned with those for cutaneous melanoma are needed.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 175-181"},"PeriodicalIF":4.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of a lifestyle modification intervention for women with overweight and obesity in a gynecologic oncology practice","authors":"David H. Morris ,&nbsp;Alison Kosmacki ,&nbsp;Leah Tolby ,&nbsp;Christine Marx ,&nbsp;Jessica Vanderlan ,&nbsp;David G. Mutch ,&nbsp;Graham Colditz ,&nbsp;Andrea R. Hagemann","doi":"10.1016/j.ygyno.2025.04.516","DOIUrl":"10.1016/j.ygyno.2025.04.516","url":null,"abstract":"<div><h3>Objective(s)</h3><div>We aimed to assess the feasibility and effectiveness of a remotely delivered, group-based lifestyle modification intervention (LMI) for women with gynecologic cancer and overweight or obesity in a real-world clinic.</div></div><div><h3>Methods</h3><div>A six-month LMI was implemented in an outpatient gynecologic oncologic clinic for women with a body mass index (BMI) &gt;25 kg/m². Participants were given a weight loss goal of ≥5 % initial body weight. Retrospective data were collected from patients enrolled in the intervention from September 2019 through February 2023. Feasibility of the LMI was assessed by the rate of enrollment and retention in the intervention. De-identified zip code data were collected to assess geographic proximity of participants to the clinic. Repeated measure analysis of variance (ANOVA) was performed to evaluate change in weight across the intervention.</div></div><div><h3>Results</h3><div>164 patients were referred to the LMI with 82 patients being enrolled during the study timeframe. The sample consisted primarily of white (68.3 %) women between the ages of 30 to 73 years old (median age of 57) with an initial median BMI of 41.41 kg/m². 74 % of enrolled patients completed the entire LMI. The LMI resulted in a mean loss of 4.19 kgs (<em>p</em> &lt; .001), with 40.30 % of patients losing ≥5 % initial body weight.</div></div><div><h3>Conclusions</h3><div>Remotely delivered, group based LMI for gynecologic cancer patients with overweight or obesity is feasible in clinical practice and can transcend rural-urban inequalities. Patients in the LMI achieved statistically and clinically significant weight loss, comparable to that observed in more rigorous clinical trial.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 168-174"},"PeriodicalIF":4.5,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative tumour size assessment in patients with early-stage cervical cancer: Final results of the SENTIX study","authors":"Martina Borčinová ,&nbsp;Christhardt Köhler ,&nbsp;Kristýna Němejcová ,&nbsp;Ignacio Zapardiel ,&nbsp;Jaroslav Klát ,&nbsp;Filip Frühauf ,&nbsp;Vladimír Kalist ,&nbsp;Wiktor Szatkowski ,&nbsp;Dariusz Wydra ,&nbsp;Roman Kocián ,&nbsp;Rene Laky ,&nbsp;Róbert Tóth ,&nbsp;Marcin Misiek ,&nbsp;Mikuláš Redecha ,&nbsp;Isabel Martin ,&nbsp;Frederic Kridelka ,&nbsp;Andrea Burgetová ,&nbsp;F. Javier Santiago Garcia ,&nbsp;Toon Van Gorp ,&nbsp;Grzegorz Szewczyk ,&nbsp;David Cibula","doi":"10.1016/j.ygyno.2025.04.005","DOIUrl":"10.1016/j.ygyno.2025.04.005","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative tumour size is a key prognostic marker in tailoring surgical treatment in early-stage cervical cancer. This post-hoc analysis assessed the accuracy of preoperative tumour size evaluation via imaging, utilizing data from the prospective, international, multicentre SENTIX study that evaluated safety of sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer.</div></div><div><h3>Methods</h3><div>Between 05/2016–09/2020, forty-seven sites across 18 countries enrolled cervical cancer patients (FIGO2018 stages 1A1/lymphovascular-space-invasion-positive to 1B2). Preoperative staging included pelvic MRI or ultrasound as mandatory imaging modalities. All patients underwent primary surgical treatment. Pathological assessment of surgical specimens served as reference standard for evaluating the accuracy of preoperative assessments.</div></div><div><h3>Results</h3><div>Among the 680 included patients, although the mean tumour size discrepancy between preoperative/pathological assessments was only 1.24 ± 8.891 mm, postoperative pT stage was upgraded in 187 (27.5 %) and downgraded in 74 (10.9 %) patients. Discrepancy of ≥10 mm was observed among 155 (22.8 %) patients across all stages, with underestimation in 105 (15.4 %), overestimation in 50 (7.4 %), and a positive correlation (<em>P</em> &lt; 0.0001) between the pathological tumour size and the discrepancy in size assessment. If a maximum 2 cm tumour size threshold were applied to guide the decision between simple and radical hysterectomy, underestimation would result in inadequate surgical management for 9.0 % of patients, whereas overestimation would lead to unnecessarily radical procedures in 5.1 % of cases.</div></div><div><h3>Conclusions</h3><div>The study highlights, that even with the use of modern imaging in preoperative staging, inaccuracies in tumour size assessment remain a common cause of up−/down-staging after surgery resulting in potential inappropriate planning of surgery, and thus in procedure that is either excessively or insufficiently radical.</div><div>Trial registration: ClinicalTrials.gov: NCT02494063.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 160-167"},"PeriodicalIF":4.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143815935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic predictors of unexpected recurrence in low-risk endometrial cancer: A comprehensive genomic analysis reveals FGFR2 as a risk factor and a rare fatal POLE-mutated recurrence","authors":"Tuukka Mettälä ,&nbsp;Titta Joutsiniemi ,&nbsp;Jutta Huvila ,&nbsp;Sakari Hietanen","doi":"10.1016/j.ygyno.2025.03.038","DOIUrl":"10.1016/j.ygyno.2025.03.038","url":null,"abstract":"<div><h3>Objective</h3><div>Endometrial cancer is the most common gynecological malignancy in high-income countries. While early-stage endometrial cancer generally has a favorable prognosis, a small proportion of low-risk patients experience unexpected recurrence. This study aimed to identify molecular factors contributing to recurrence in stage 1 A grade 1–2 low-risk endometrioid endometrial cancer.</div></div><div><h3>Methods</h3><div>We performed next-generation sequencing (NGS) on tumor samples from 19 patients who experienced recurrence despite favorable clinicopathological features and compared them with six control patients without recurrence. Results were also compared to a matched cohort of low-risk endometrial cancers from The Cancer Genome Atlas (TCGA) database.</div></div><div><h3>Results</h3><div>Mutations in PTEN, PIK3CA, ARID1A, and FGFR2 were the most frequent in the recurrence group. FGFR2 mutations were exclusive to the recurrence group (9/19, 47.4 %) and absent in the non-recurrent group (0/6), a difference approaching statistical significance (<em>p</em> = 0.0571). FGFR2 mutations were also significantly more prevalent in the recurrence cohort compared to the TCGA low-risk cohort (<em>p</em> = 0.0039). Prominent FGFR2 missense mutations included S252W, K659E, and N549K, which may drive oncogenesis and tumor progression. Among the recurrence group, a rare POLE-mutated tumor recurred unexpectedly and proved fatal, highlighting the potential for poor outcomes even in typically favorable molecular subtypes.</div></div><div><h3>Conclusion</h3><div>FGFR2 mutations may play a role in tumor recurrence in a subset of low-risk endometrial cancers, underscoring the importance of molecular profiling in identifying patients at risk. FGFR2 represents a potential therapeutic target, warranting further validation in larger cohorts to establish its clinical utility.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hysterectomy or not for borderline ovarian tumor in menopause?","authors":"Diego Raimondo ,&nbsp;Antonio Raffone ,&nbsp;Manuela Maletta ,&nbsp;Stefano Restaino ,&nbsp;Martina Arcieri ,&nbsp;Lorenza Driul ,&nbsp;Antonio Travaglino ,&nbsp;Anna Myriam Perrone ,&nbsp;Anna Fagotti ,&nbsp;Floriana Mascilini ,&nbsp;Mario Malzoni ,&nbsp;Francesca Falcone ,&nbsp;Giorgio Bogani ,&nbsp;Stefano Ferla ,&nbsp;Fabio Landoni ,&nbsp;Roberto Berretta ,&nbsp;Marcello Ceccaroni ,&nbsp;Stefania Cicogna ,&nbsp;Francesco Pantano ,&nbsp;Giuseppe Trojano ,&nbsp;Renato Seracchioli","doi":"10.1016/j.ygyno.2025.03.052","DOIUrl":"10.1016/j.ygyno.2025.03.052","url":null,"abstract":"<div><h3>Background</h3><div>The role of hysterectomy for borderline ovarian tumor (BOT) among postmenopausal women is still unclear.</div></div><div><h3>Objective(s)</h3><div>To assess the impact of hysterectomy on survival outcomes in postmenopausal women with BOT.</div></div><div><h3>Study design</h3><div>This study was a national, multicenter, observational, retrospective, cohort study including all consecutive eligible postmenopausal patients who underwent primary surgery for BOT in 20 Italian centers from January 2005 to December 2017. Patients were divided into two groups: hysterectomy group vs no-hysterectomy group. Primary outcome was disease-free survival (DFS) at 5 years of follow-up; secondary outcomes were overall survival (OS) and disease-specific survival (DSS) at 5 years of follow-up, hazard ratio (HR) for recurrence, death of any cause and death due to BOT, peri-operative complications rates.</div></div><div><h3>Results</h3><div>483 patients were included, 144 (29.8 %) women in the no-hysterectomy group and 339 (70.2 %) in the hysterectomy group. Recurrences were significantly more common in the no-hysterectomy group compared to hysterectomy one (8.3 % vs 2.7 %; <em>p</em> = 0.012). The 5-year DFS rate was lower in the no-hysterectomy group than that in the hysterectomy one [92.4 % vs 98.5 %; <em>p</em> = 0.007]. At univariate analyses, women who underwent hysterectomy showed HR of 0.312 (95 %CI:0.131–0.740; <em>p</em> = 0.008) for recurrence. At multivariate analysis, hysterectomy was found to be an independent protective factor for recurrence (HR: 0.253, 95 %CI:0.103–0.618, <em>p</em> &lt; 0.003).</div></div><div><h3>Conclusions</h3><div>In postmenopausal women with BOT, hysterectomy is associated with a decreased risk of recurrence, while it does not affect the risk of death from any cause or death due to the disease. Based on these findings, hysterectomy should be routinely integrated into the surgical staging of BOT in postmenopausal women.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 152-159"},"PeriodicalIF":4.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of indocyanine green (ICG) for sentinel lymph node detection in vulvar cancer","authors":"Karlijn M.C. Cornel ,&nbsp;Meera P. Mehta ,&nbsp;Brenna E. Swift ,&nbsp;Allan Covens ,&nbsp;Danielle Vicus ,&nbsp;Rachel S. Kupets ,&nbsp;Lilian T. Gien","doi":"10.1016/j.ygyno.2025.03.039","DOIUrl":"10.1016/j.ygyno.2025.03.039","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to evaluate the use of indocyanine green (ICG) as a detection modality in sentinel lymph node (SLN) procedures for vulvar cancer.</div></div><div><h3>Method</h3><div>A retrospective cohort study was performed from January 2008–August 2022 including all patients who underwent a SLN procedure for ≤4 cm vulvar cancer tumors with clinically/radiological normal inguinal nodes. SLN procedures with Tc99 +/− blue dye were compared to those with ICG +/− Tc99. Patient and tumor characteristics were collected as well as short-term and long-term complications. A subset analysis of SLN procedures with ICG alone was described.</div></div><div><h3>Results</h3><div>A total of 229 patients were included, representing 365 groins. Detection modality was Tc99 +/−blue dye in 189 patients (304 groins) and ICG +/-Tc99 in 40 patients (60 groins). The SLN detection rate for Tc99 +/− blue dye was 93.4 % and for ICG +/− Tc99 90.3 % (<em>p</em> = 0.4). The SLN was positive in 17.3 % of the Tc99 +/− blue dye group vs 23.2 % in the ICG +/− Tc99 group (<em>p</em> = 0.3). There was no significant difference in short- or long-term complications.</div><div>The detection rate among 15 patients (22 groins) where ICG was used as a single modality was 90.9 %. There were no specific patient or tumor characteristics related to SLN mapping failure.</div></div><div><h3>Conclusion</h3><div>The use of ICG +/− Tc99 as detection modality shows promising results with a success rate comparable to Tc99 +/− blue dye, supporting the use of ICG. Future studies are needed to confirm the efficacy and long-term safety of ICG alone.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 146-151"},"PeriodicalIF":4.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognostic potential of molecular subtypes including estrogen receptor status in endometrioid ovarian cancer","authors":"Hein S. Zelisse ,&nbsp;Malou L.H. Snijders ,&nbsp;Floris H. Groenendijk ,&nbsp;Johannes B.G. Halfwerk ,&nbsp;Gerrit K.J. Hooijer ,&nbsp;Willemien J. van Driel ,&nbsp;Alicia León-Castillo ,&nbsp;Christianne A.R. Lok ,&nbsp;Loes F.S. Kooreman ,&nbsp;Sandrina Lambrechts ,&nbsp;Eva-Maria Roes ,&nbsp;Roy J. Reinten ,&nbsp;Marlou Heeling ,&nbsp;Noah J. Sandel ,&nbsp;Ronald van Marion ,&nbsp;Frederike Dijk ,&nbsp;Marc J. van de Vijver ,&nbsp;Constantijne H. Mom ,&nbsp;Mignon D.J.M. van Gent","doi":"10.1016/j.ygyno.2025.03.050","DOIUrl":"10.1016/j.ygyno.2025.03.050","url":null,"abstract":"<div><h3>Background</h3><div>The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) has been shown to be applicable to endometrioid ovarian cancer (ENOC), classifying tumors into four molecular subgroups: <em>POLE</em> mutated (POLEmut), mismatch repair deficient (MMRd), p53 abnormal (p53abn), and no specific molecular profile (NSMP). However, the large NSMP subgroup in ENOC limits its clinical applicability. Incorporating estrogen receptor (ER) status has improved prognostic accuracy in NSMP endometrial cancer. Therefore, this study investigated the prognostic value of ER status in the molecular subgroups of ENOC.</div></div><div><h3>Methods</h3><div>In this multicenter, retrospective cohort study, paraffin-embedded tumor tissue from surgically treated ENOC patients (1994–2021) was used for molecular classification. ER status was determined by immunohistochemistry. Survival analysis was performed using the log-rank test and Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Of the 167 included patients, 1.2 % had a POLEmut tumor, 6.6 % an MMRd tumor, 11.4 % a p53abn tumor, and 80.8 % an NSMP tumor. ER status was negative in 12 % of tumors, correlating with a significantly lower 10-year overall survival rate compared to ER-positive tumors (HR 3.51, 95 % CI 1.75–7.01, <em>p</em> &lt; .001). No ER-negative tumors were found in the POLEmut and MMRd subgroups, and ER status was not prognostic in the p53abn subgroup. In the NSMP subgroup, 11.1 % of tumors were ER-negative, showing a worse 10-year overall survival rate (HR 3.92, 95 % CI 1.67–9.21, <em>p</em> = .002).</div></div><div><h3>Conclusion</h3><div>ER status improves prognostic stratification within the NSMP subgroup in ENOC, with ER-negative tumors associated with a worse prognosis. These findings may lead to more personalized treatment strategies for ENOC.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 137-145"},"PeriodicalIF":4.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anastomotic leakage in colorectal and ovarian cancer resections: A comparative cohort study","authors":"Radwa Hablase ,&nbsp;Jacqueline Steinke ,&nbsp;Aqsa Aslam ,&nbsp;Rhea Jose ,&nbsp;Konstantinos Palaiologos ,&nbsp;Christina Uwins ,&nbsp;Anil Tailor ,&nbsp;Jayanta Chatterjee ,&nbsp;Patricia Ellis ,&nbsp;Hersha Patel ,&nbsp;Andrea Scala ,&nbsp;Simon Butler-Manuel","doi":"10.1016/j.ygyno.2025.03.028","DOIUrl":"10.1016/j.ygyno.2025.03.028","url":null,"abstract":"<div><h3>Objective</h3><div>To compare anastomotic leak (AL) rates after colorectal resections performed by colorectal surgeons in ovarian and colorectal cancer surgeries, examining predictive risk factors, short-term and survival outcomes, and early AL markers in ovarian cancer patients.</div></div><div><h3>Methods</h3><div>Single-centre retrospective study comparing AL rates between 233 ovarian debulking surgeries from January 1, 2010, to December 31, 2022, and 408 gender-matched colorectal cancer patients from January 2014 to December 2022 at the Royal Surrey NHS Foundation Trust, UK. Predictive risk factors were assessed using logistic regression and the overall survival using log-rank tests and Cox proportional hazards model. Receiver operating characteristic (ROC) curves were plotted for C-reactive protein (CRP) values from postoperative days one to five.</div></div><div><h3>Results</h3><div>19 % of ovarian cancer patients underwent colorectal resection, of which 90 % had primary anastomosis. AL rates were 4.7 % and 1.9 % (<em>p</em> = 0.08) for the ovarian and colorectal groups respectively. Covering stoma rates were 11.6 % in the ovarian and 15 % in the colorectal group. 80 % in the ovarian group had rectosigmoid resections. Delays in chemotherapy and residual disease were independent risk factors for increased risk of death in ovarian interval debulking surgery. HR 1.03 (95 % CI: 1.01–1.05, <em>p</em> = 0.008) and HR 2.02 (95 % CI: 1.11–3.68, <em>p</em> = 0.021). CRP on days three and four had a 98 % negative predictive value at a cut-off of 286 mg/L and 232 mg/L, respectively.</div></div><div><h3>Conclusion</h3><div>Ovarian cancer patients are at high risk of AL. Preventative measures should be considered. Low CRP on post-operative days three and four may be used exclude AL.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 121-128"},"PeriodicalIF":4.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECPPF stratification identifies occult high-risk subgroups in stage I, grade 1 or 2, ≤50 % invasive endometrial cancer: Candidates for adjuvant therapy","authors":"Jesus Gonzalez-Bosquet ,&nbsp;Maryam Shahi ,&nbsp;Siddhartha Yadav ,&nbsp;Nisha Kanwar ,&nbsp;Saba Alvand ,&nbsp;Carlos Sosa ,&nbsp;Sean C. Dowdy ,&nbsp;Kevin C. Halling ,&nbsp;S. John Weroha ,&nbsp;Jamie N. Bakkum-Gamez ,&nbsp;Karl C. Podratz","doi":"10.1016/j.ygyno.2025.03.030","DOIUrl":"10.1016/j.ygyno.2025.03.030","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether stratification with ECPPF (<em>E2F1</em> + <em>CCNA2</em> log2 expression and <em>POLE</em>, <em>PPP2R1A,</em> and <em>FBXW7</em> variants) could identify occult cases of high-risk endometrial cancer (EC) in a traditionally low-risk cohort.</div></div><div><h3>Methods</h3><div>We identified 97 cases of clinicopathologic low-risk endometrioid EC (defined as stage I, grade 1 or 2, limited [≤50 %] myometrial invasion) from The Cancer Genome Atlas (TCGA). Twelve cases had <em>POLE</em> mutations (mu) and 15 had <em>PPP2R1A</em>mu or <em>FBXW7</em>mu. Log2 <em>CCNA2</em> <em>+</em> <em>E2F1</em> expression was low (&lt;4.75) for 56 cases and high (&gt;4.75) for 19 (termed <em>CCNA2</em> <em>+</em> <em>E2F1 low</em> or <em>high</em>, respectively). <em>CCNA2</em> <em>+</em> <em>E2F1</em> high and <em>PPP2R1A</em>mu/<em>FBXW7</em>mu were simultaneously present for 5 cases. Survival comparisons were based on log-rank tests.</div></div><div><h3>Results</h3><div>Five-year progression-free survival (PFS) curves for <em>POLE</em>mu and <em>CCNA2</em> <em>+</em> <em>E2F1</em> low differed substantially from <em>CCNA2</em> <em>+</em> <em>E2F1</em> high and <em>PPP2R1</em>mu/<em>FBXW7</em>mu cases (<em>P</em> &lt; .001). The latter 2 subgroups, combined (<em>n</em> = 29) and designated as <em>molecular high risk</em> (MHR), had an estimated 5-year PFS &lt;50 %. Adverse outcomes were associated with MHR for cases harboring <em>CTNNB1</em>mu (<em>P</em> &lt; .001), <em>ARID1A</em>mu (<em>P</em> = .03), and <em>PTEN</em>mu (<em>P</em> = .002). TCGA classification was not prognostically significant for this cohort (<em>P</em> = .10), but ECPPF MHR identified compromised subgroups within major TCGA subclasses (<em>P</em> = .004). <em>CCNA2</em> <em>+</em> <em>E2F1</em> high and expression of its downstream targets were positively correlated (<em>P</em> &lt; .001) with expression of genes involved in chemoresistance (ie, homologous recombination, cell cycle regulation, antiapoptotic processes).</div></div><div><h3>Conclusions</h3><div>ECPPF supports a taxonomy in which occult, high-risk disease is identified among cases traditionally considered low risk. With high-risk cases unlikely to respond to current first-line chemotherapy, case identification should prompt proactive therapeutic intervention with alternative molecular-based treatment targets.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 113-120"},"PeriodicalIF":4.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring endometrial cancer risk stratification by copy number assessment","authors":"Casey M. Cosgrove ,&nbsp;Adrian A. Suarez ,&nbsp;Paulina J. Haight ,&nbsp;Alyssa Villacres ,&nbsp;Alexis Chassen ,&nbsp;Keith Brownewell ,&nbsp;Joseph P. McElroy ,&nbsp;Jessica Gillespie ,&nbsp;David E. Cohn ,&nbsp;Paul J. Goodfellow","doi":"10.1016/j.ygyno.2025.03.037","DOIUrl":"10.1016/j.ygyno.2025.03.037","url":null,"abstract":"<div><h3>Background</h3><div>Contemporary management of endometrial cancer includes molecular classification. The primary objective of this study was to assess the prognostic significance of copy number changes evidenced by loss of heterozygosity (LOH) or allelic imbalance (AI).</div></div><div><h3>Methods</h3><div>Sequencing including <em>TP53</em>, <em>POLE</em> and MSI testing was performed. AI/LOH at 5 polymorphic markers (<em>D2S123, D5S2346, D17S250, D17S516</em> and <em>D17S1818</em>) was assessed. Micro-satellite stable (MSS) endometrial tumors were classified as having evidence of AI/LOH or no evidence of AI/LOH.</div></div><div><h3>Results</h3><div>482 MSS cases were evaluated for AI/LOH status. There were 226 (46.5 %) tumors with evidence of AI/LOH at ≥1 of the 5 markers and these were significantly associated with patients of older age and lower body mass index as well as tumors that were non-endometrioid histology, higher grade, demonstrated LVSI, and presented at more advanced stage. Most patients who developed recurrent disease had a tumor with AI/LOH (82.1 %). 3-year progression-free survivals (PFS) were 79.5 % in the AI/LOH group vs 95.6 % in the no AI/LOH group (<em>p</em> &lt; 0.0001). <em>TP53</em> mutation status was associated with PFS. 3-year PFS was significantly worse for the <em>TP53</em> mutated group at 55 % vs 96 % in <em>TP53</em> wild-type (<em>p</em> &lt; 0.0001). Of the 373 cases classified as having no specific molecular profile there was a 6.2 % recurrence rate with AI/LOH and 3.3 % recurrence with no AI/LOH.</div></div><div><h3>Conclusions</h3><div>AI/LOH assessment at a limited number of markers identifies endometrial cancers with higher risk features that are more likely to recur. Copy-number assessment utilizing clinically accessible testing strategies can provide an opportunity for improved risk stratification.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"196 ","pages":"Pages 99-106"},"PeriodicalIF":4.5,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}